Traumatic Incident Reduction
Traumatic incident reduction is a brief, one-on-one, person-centered, simple and highly structured method for permanently eliminating the negative effects of past traumas. It involves repeated viewing of a traumatic memory under conditions designed to enhance safety and minimize distractions. The client does all the work; the therapist or counselor offers no interpretations or negative or positive evaluations, but only gives appropriate instructions to the client to have him view a traumatic incident thoroughly from beginning to end. Hence, we use the term "viewer" to describe the client and "facilitator" to describe the person who is helping the client through the procedure by keeping the structure of the session intact and giving the viewer something definite to do at all times. The facilitator confines herself simply to giving a series of set instructions to the viewer; she offers no advice, interpretations, evaluations, or reassurances. The viewer locates a specific trauma that he is interested in working on — one with a specific, finite duration. Then he treats the incident like a "videotape". First, he "rewinds" it to the beginning, then "plays" it through to the end — without talking about it while he is viewing it. After he has viewed it, the facilitator then asks him what happened, and he can then describe the event or his reactions to going through it. After the viewer has completed one review (and one description), the facilitator has him "rewind the videotape" to the beginning and run through it again in the same fashion. The facilitator does not prescribe the degree of detail, sensory modalities, or content the viewer is to get on each run-through. The viewer will view as much as he is relatively comfortable viewing. After several run-throughs, most viewers will become more courageous, contacting the emotion and uncomfortable details more and more thoroughly. Typically, the viewer will reach an emotional peak after a few run-throughs and then, on successive run-throughs, the amount of negative emotion will diminish, until the viewer reaches a point of having no negative emotion about the incident. Instead, he becomes rather thoughtful and contemplative, and usually comes up with one or more insights -- often major- concerning the trauma, life, or himself. He displays positive emotion, often smiling or laughing, but at least manifesting calm and serenity. At this point, the viewer has reached an "end point" and the facilitator stops the TIR procedure. A TIR session is not ended until the viewer reaches an end point and feels good. This may take anywhere from a few minutes to 3-4 hours. Average session time for a new viewer is about 90 minutes. Average total session hours to eliminate the symptoms of post-traumatic stress disorder is 15 (usually about 10 sessions). Origins of TIR Frank A. Gerbode,.M.D. developed TIR by investigating Dianetics and working back to the origins of the Dianetics technique, then in use by the Church of Scientology. Until 1982 he had been a member of the Church of Scientology, at one time running the Palo Alto Mission of Scientology. After his departure, the Church of Scientology sued Dr. Gerbode; the suit culminated in a settlement in 1994. What is TIR useful for? TIR proponents claim that it is highly effective in eliminating the negative effects of past traumatic incidents. However, it should be noted that TIR does not at present meet the American Psychological Association's criteria for an empirically supported treatment due to insufficient published studies to support claims being made. Nevertheless, proponents claim that it is especially useful when: a. A person has a specific trauma or set of traumas that she feels has adversely affected her, whether or not her condition meets the clinical definition of post-traumatic stress disorder. b. A person reacts inappropriately or overreacts in certain situations, and it is thought some past trauma might have something to do with it. c. A person experiences unaccountable or inappropriate negative emotions, either chronically or in response to certain experiential triggers. TIR has been in use since 1984 in something similar to its current form. It has undergone minor modifications over the years, mostly in the interests of greater simplicity and teachability. TIR proponents claim that in the great majority of cases, TIR correctly applied results in the complete and permanent elimination of PTSD symptoms, although there are to date, no published studies to support this claim. They also claim that it provides valuable insights, which the viewer arrives at quite spontaneously, without any prompting from the facilitator and hence can "own" entirely as his own. By providing a means for completely confronting a painful incident, TIR lets a client gain from fully confronting the trauma. What are the contraindications and risks of TIR? TIR is contraindicated for use with clients who: a. Are psychotic or nearly so. TIR is most definitely an "uncovering" technique and hence is not appropriate for such clients. b. Are currently abusing drugs or alcohol. TIR is not useful for detoxifying clients. A client should be stably off drugs or alcohol for two months before starting TIR. However a special TIR program addressed to drugs can be very effective in preventing recidivism. c. Are not making a self-determined choice to do TIR. For TIR to work, the client has to really want to do it. If the client is there under duress (e.g., on court order) or trying to please someone, TIR will not work. It may be possible, however, to explain to a reluctant client what TIR is and "sell" him on the idea of doing it. But the client must be well-motivated before starting. d. Are in life situations that are too painful or threatening to permit them to concentrate on anything else, such as a TIR session. If the client is afraid of being murdered, or is preoccupied about the possibility of having cancer, or engaged in constant fighting with her spouse, such issues/situations would have to be addressed first, by in-vivo behavioral interventions or other means, before the client will be ready to do TIR. e. Have no interest in or attention on past traumas. A general rule is to follow the interest of the client. If, when the client isn't interested in looking at past traumas, you address what the client is interested in looking at, the client may then become interested in looking at past incidents. Since the TIR technique is completely client-titrated, client-timed, and non-forceful, clients will protect themselves if they are getting in too deeply by simply discontinuing the procedure. Hence there are no known cases of negative effects from properly facilitated TIR. If the facilitator tries to force the client to run an incident, TIR may cause a considerable (though temporary) upset. But one of the cardinal rules of facilitation is never to force the client and always to follow the client's interest. Since TIR practitioners follow the client's interest at all times, they encounter little resistance. If the client resists, we consider that we are not addressing the material the client should be looking at, at present. Historical antecedents of TIR TIR grew mainly out of the work of Carl Rogers, Sigmund Freud and Scientology. In Two Short Accounts of Psycho-Analysis ISBN 0-14-013654-1, Freud describes a method to resolve sequences of similar traumas: :"What left the symptom behind was not always a single experience. On the contrary, the result was usually brought about by the convergence of several traumas, and often by the repetition of a great number of similar ones. Thus it was necessary to reproduce the whole chain of pathogenic memories in chronological order, or rather in reversed order, the latest ones first and the earliest ones last; and it was quite impossible to jump over the later traumas in order to get back more quickly to the first, which was often the most potent one." Freud later abandoned this technique in favor of free-association. It seems likely that (in retrospect) the reason it didn't work well was the degree of "interference" the analyst introduced by interpretations and by forcing the analysand in various ways, and the lack of a systematic, repetitive approach to achieving the desired medical history. The work of Carl Rogers was invaluable in providing rules -- such as a proscription against interpretations and evaluations -- and an overall viewpoint of respect for the authority of the client, both of which tend to help create a safe environment for running TIR. Although Rogers first described his work as "non-directive" and later as "person-centered", it seems obvious to me that "non-directive" doesn't mean the same thing as "person-centered". "Person-centered" describes the attitude of respect for the superior authority of the client and the concomitant rules for not stepping on the client's reality. "Non-directive" means the client gives structure to the session. These two are actually orthogonal to each other. For instance, classical, free-associative psychoanalysis is non-directive, but not person-centered. Cognitive and behavioral therapy are non-person-centered (because the therapist disputes the reality of the client) and directive (the therapist determines the agenda). Rogers is non-directive and person-centered. TIR falls into the fourth category: person-centered and directive. In addition, Gerbode credits the gradient repetitive procedures of "systematic desensitization" developed from the behavior therapy of Joseph Wolpe, as instrumental in his formulation of metapsychological procedures. Various alternative techniques, including Gestalt Therapy, Cognitive behavior therapy, and Rational Emotive Therapy contributed materially to the subject of metapsychology. Dr. Gerbode was also strongly influenced by the ideas of the Hungarian psychiatrist Thomas Szasz, who objected to the labeling of people as "mentally ill" simply because they were undergoing cognitive or emotional disturbances. For this same reason, metapsychology rejects the traditional forms of diagnosis and the "healer/patient" medical model, choosing to call its procedures viewing rather than "therapy". In addition to removing any stigma from the practice of viewing, this nonevaluative, non-judgmental approach to mental exploration returns appropriate dignity to the one who is doing the real work -- the viewer. Non-person centered Person-centered Directive Cognitive and Behavioral Therapies TIR and Applied Metapsychology Non-Directive Classical, free-associative psychoanalysis Pure Rogerian TIR shows clear antecedents in Gerbode's time in Scientology. It may optionally use a galvanic skin response meter similar to the E-meter, although this has not been taught in the TIR Workshop since 1990. (The 4-day TIR Workshop is considered sufficient for basic proficiency). It strongly resembles Dianetics, with variations in technical jargon. See also Scientology beliefs and practices. How and why does TIR work? Freud based his work on the theory that in order to recover from past traumas, it is necessary to achieve a full anamnesis (recovery of lost memory). He never adequately explained why anamnesis was necessary, however. I would like to propose a person-centered explanation. A trauma, by definition, is an incident that is so painful, emotionally or physically, that one tends to flinch away from it, not to let oneself be aware of it, or, in Freud's terms, to repress it. It is the flinch and not the "objective" description of the incident that makes it a trauma. Hence an event that is challenging and exciting for one individual may be traumatic for another. The one for whom it is a mere challenge is able to "stay with it" and master it; the one who experiences it as a trauma is not. By definition, then, a trauma contains repressed material. Contained in a trauma, too, is one or more intentions. At the very least, there is the intention to push it away, to blot it out, to repress it. And there are usually other intentions as well, such as the intention to fight back, to get revenge, to run away, or (quite commonly) the intention to make sure that nothing like this incident ever happens again. From a person-centered viewpoint, an intention is simply the most proximal, the most subjective part of an activity. If I intend to win a race, from that intention flows all the means I use to win it: the various movements of my muscles, leading to forward movement of my body and ultimately to pulling ahead of the other racers, etc. In other words, the intention is the beginning of the action, and the consequences flow outward to become manifest physically. An activity continues so long, and only so long, as the corresponding intention exists. That means that for each ongoing intention, there is an activity (at least a mental one) that continues as part of the here and now. In fact, people subjectively define time in terms of the activity they are engaged in. Objectively, time is a featureless continuum. But people perceive time as is divided up into chunks or "periods". For every given activity (and for every given intention) there is a corresponding period of time, and so long as you have an intention, you remain in the period of time defined by that intention (and activity). Holding onto an intention holds you in the period of time that commenced with the formulation of that intention. There are only two ways of ending an intention: # Fulfilling the intention, whereupon it ends spontaneously. You can't keep intending to win a race after you have won it. # Unmaking it. Even if you don't fulfill an intention, you can decide not to have that intention anymore and cause it to end. This, however, requires a conscious decision. You have to be aware of the intention and why you formed it. But if the intention is buried in the middle of a repressed trauma, neither condition can be satisfied, and the intention persists indefinitely. The person remains in the period of time defined by that intention, i.e., the person remains in the traumatic incident! The incident floats on as part of present time and is easily triggered (i.e., the person is easily reminded of it, consciously or unconsciously). The only way a person can exit from that period of time (and from the intentions, feelings and behaviors engendered by the trauma) is by confronting the incident, whereupon one can see: a. What intentions were formulated at the time of the incident. b. Why they were formulated at that time. Then, and only then, one can satisfy condition (2), above, for ending an intention, and one can let go of the intention. Without a thorough anamnesis, condition (2) cannot be satisfied. How does TIR compare with other techniques for addressing traumatic stress? Up until recently, there have been two main approaches to PTSD: # Coping techniques. # Cathartic techniques Some therapists give their clients specific in vivo methods for counteracting or coping with the symptoms of PTSD. These clients learn to adapt to, to live with, their PTSD condition. They learn, for instance, how to avoid situations that trigger them, how to distract themselves when they are triggered, how to rebreathe in a paper bag to avoid hyperventilation. Women who have been assaulted or raped may take self-defense classes. Others encourage their clients to "release their feelings", to have a catharsis. The idea is that past traumas generate a certain amount of negative energy or "emotional charge'", and the therapist's task is to work with the client to release this charge so that it does not manifest itself as aberrant behavior, negative feelings and attitudes, or psychosomatic conditions. This notion, derived from Freud's libido theory, is an "hydraulic" theory of psychopathology. Charge generated in past traumas supposedly exerts a pressure towards its expression. If not expressed in affect appropriate to the experienced trauma, it must express itself in inappropriate ways. Therapists espousing this theory use methods such as implosion therapy, psychodrama, and focus groups to help the client release the charge. Coping methods and cathartic techniques may help a person to feel better temporarily, but they don't actually improve the client's stability. Instead, what you get is a "Chinese Dinner Syndrome", so called on an analogy to the relatively large proportion of short-term energy (from carbohydrates) in Chinese cuisine: clients feel better temporarily after coping or having a catharsis, but the basic charge remains in place, and shortly thereafter they are hungry for more therapy. In cathartic work, the presence of an affective discharge indicates that the client has contacted a past trauma and "worked it through", but not that she has eliminated it. Coping strategies don't provide a permanent solution either. A week, a day, or an hour later, some random environmental stimulus such as a loud noise or the sound of helicopters can trigger anew the same charge. TIR could be regarded as a kind of "exposure technique", in that, as with exposure, the point of TIR is to help the viewer become more aware of the traumatic incident. Exposure theorists rely on a desensitization model, in contradistinction to TIR's person-centered model, but the two techniques converge on the need for repeated exposure to the trauma. (Editors note: Direct therapeutic exposure is a tool long used by the United States Department of Veterans Affairs and others to treat PTSD. A dissertation, which has not been published in any peer reviewed journal by TIR proponentLori Beth Bisbey has shown DTE to be more effective than no intervention at all, but not as effective as TIR.) There are certain features of TIR that do not form part of the DTE approach, however: a. TIR embodies the concept of an end point, with certain particular characteristics. DTE's "end point" occurs when the client feels little or no distress as a result of confronting the incident. In TIR, we usually await the onset of positive emotion, not just the absence of negative emotion. Plus there are the other components of an end point, as described in TIR: insight, extroversion, and frequently the expression of what the intention was that the viewer made in the incident. b. TIR is stricter about not permitting any input from the facilitator concerning detail or content of the incident. In DTE, the therapist reads a script to the viewer, and the viewer goes through at the therapist's pace. In TIR the viewer confronts only what she feels comfortable confronting on any particular run-through. Exposure in TIR is client-titrated, rather than therapist-titrated. c. In TIR, we endeavor to reach an end point in a single session; in DTE, working on a given incident typically takes a few sessions. d. TIR includes specific ways of checking for earlier and similar incidents that might be triggered when running through a later one. A sequence of incidents can be traced back to its root in a single session and resolved. e. When the client suffers from unaccountable uncomfortable feelings, emotions, sensations, psychosomatic pains, and unwanted attitudes, but there are no obvious major traumas in evidence that could be addressed, a type of TIR called "Thematic TIR" can be used to trace these "themes" back to the incidents they came from and eliminate them, also in a single session. More recently, proponents of certain techniques have claimed that they can permanently eliminate the effects of PTSD. Charles Figley and Joyce Carbonell at Florida State University have recently studied these techniques -- TIR, Francine Shapiro's Eye Movement Desensitization and Reprocessing (EMDR), NLP's Visual / Kinesthetic Disassociation (VKD), and Roger Callahan's Thought Field Therapy (TFT) -- to determine what the active ingredient was. However, this study was not designed as an outcome study, thus no conclusions can be drawn about the efficacy of these techniques from that study. The complete results of Figley's study are available in the book Traumatic Incident Reduction: Research and Results ISBN 1-932690-11-5. Also in this volume are synopses of three doctoral research projects including those of LoriBeth Bisbey, PhD (TIR and crime victims, 1994), Wendy Coughlin, PhD (TIR and Panic Disorders, 1994), and Pamela V. Valentine, PhD (TIR and incarcerated females, 1996). Like TIR, EMDR and VKD contain elements of exposure, but they also contain other elements, such as inducing eye movements or producing other repetitive, bilateral stimuli (as in EMDR) or creating a deliberate state of dissociation (as in VKD). Otherwise they differ from TIR in the same ways that DTE does. TFT is utterly different from TIR, relying, as it does, on manipulating acupuncture meridians. Metapsychology Background of metapsychology "I may use the name of metapsychology for any psychology that leads behind consciousness," wrote Sigmund Freud nearly a century ago. In his system of psychoanalysis, Freud had incorporated the concept of abreaction, or "the talking cure", from his own mentor Josef Breuer. It was based on a recalling or re-experiencing of those stressful or disturbing situations or events which precipitated a neurosis. Freud noted that the key to a recent disturbance lay in an earlier, similar trauma - sometimes an entire "chain" of traumatic incidents. This is the foundation for the theory and procedures developed by Frank A. Gerbode, M.D., which are part of the subject of metapsychology. Like any other general subject of study, metapsychology is not committed to a specific method, nor to a fixed belief system. It is the study of the origin, structure, and function of the mind and of the relationship between the mind or spirit and the physical universe. It is a study of the individual, his abilities, and his experience, as seen from his point of view. It picks up where psychology, as the science of behavior, leaves off. Hence the name "meta-psychology" has the correct connotation of being a study that goes "beyond" psychology -- beyond the study of behavior to the study of that which behaves -- the person himself, and the person's perceptual, conceptual, and creative activity, as distinguished from the actions of his body. In this sense, "metapsychology" restores the original meaning of "psychology" as "the study of the soul, or spirit", and the applications of metapsychology reflect the perennial common goal of both therapy and religion, whether one calls this goal the attainment of sanity, of enlightenment, of happiness, or of salvation. We sometimes abbreviate "metapsychology" as "MP". Until relatively recently, enlightenment was the exclusive concern of religions or spiritual disciplines, in their various forms, cultish or otherwise. Currently, certain forms of therapy (principally the various Humanistic or "Transpersonal" therapies, including Existential and Jungian analysis) have often also had a form of enlightenment as their goal, and some progress has been made towards understanding what needs to be done in order to attain this state. However, enlightenment, or high awareness and ability, and the non-material nature of a person or individual can also be the objects of a formal discipline, science, or subject of study whose purpose is the attainment of understanding of life at its deepest level. Proponents of TIR see metapsychology as a generic field of study embracing the truths that have been discovered in all these disciplines. It does not need to be crystallized and fixated into a proprietary religion, cult, therapy, or belief system that bears a proper name or trademark. Rather, it can be, and ought to be, regarded as a legitimate discipline in itself, like physics, chemistry, biology, and philosophy. As such, metapsychology can improve our understanding of the various non-generic mental and spiritual disciplines, and it is no more incompatible with, say, Christianity or Freudianism than, for instance, the study of organic chemistry is incompatible with a study of Bayer's method of synthesizing aspirin or Exxon's method of refining oil. A study of metapsychology should lead to the discovery of basic truths that underly the various psychologies, therapies, religions, and belief systems and should, therefore, be able to relate these systems to each other. Metapsychology is based on a combined phenomenological and pragmatic approach called the "being-centered method". If we hope to succeed in getting others to accept our viewpoint on the world, we must present this viewpoint in a way that others can accept, in a way that allows others to perceive the truthfulness (or falsity) of what we are saying, based on their own experience. This constraint also limits we to describing things that are a part of other people's experiences or congruent with those experiences. We cannot spin theories about hypothetical objects that are unrelated to common observations and expect to be believed. Thus the pragmatic method and the phenomenological method converge in the being-centered method. If we cease talking about some hypothetical world outside of experience and limit ourselves to what people do experience commonly, then we are being both phenomenologists and pragmatists. Throughout our discussion of metapsychology, we will be constantly consulting experiences that all people have in common, as the basis for our assertions. The reader can, by consulting his own experience, verify or disprove for himself each of these points. The only claim for acceptance of the concepts of metapsychology is the assumption that different people have a great deal in common in what they experience and the way in which they experience it. This interpersonal commonality of experience is the fundamental truth which we are seeking in metapsychology. The truths we have discovered -- and hope to discover in the future -- can be applied to enhance greatly the quality of life. Early influences in the development of metapsychology In addition to Breuer and Freud, Gerbode credits Carl Rogers’ "client-centered" approach to therapy, and the gradient repetitive procedures of "desensitization" developed from the behavior therapy of Joseph Wolpe, as instrumental in his formulation of metapsychological procedures. Various alternative techniques, including Gestalt Therapy, Cognitive behavior therapy, Dianetic Therapy, and Rational Emotive Therapy contributed materially to the subject of metapsychology. Dr. Gerbode was also strongly influenced by the ideas of the Hungarian psychiatrist Thomas Szasz, who objected to the labeling of people as "mentally ill" simply because they were undergoing cognitive or emotional disturbances. For this same reason, metapsychology rejects the traditional forms of diagnosis and the "healer/patient" medical model, choosing to call its procedures viewing rather than "therapy". In addition to removing any stigma from the practice of viewing, this nonevaluative, non-judgmental approach to mental exploration returns appropriate dignity to the one who is doing the real work- the viewer. Medical history in TIR Most common approaches to post-traumatic stress reduction fall into two categories: coping techniques and cathartic techniques. Some therapists give their clients specific in vivo (literally “in life") methods for counteracting or coping with the symptoms of PTSD — tools to permit their clients to learn to adapt to, to learn to live with, their PTSD condition. Others encourage their clients to release their feelings, to have a catharsis. The idea is that past traumas generate a certain amount of negative energy or “emotional charge”, and the therapist’s task is to work with the client to release this charge so that it does not manifest itself as aberrant behavior, negative feelings and attitudes, or psychosomatic conditions. Coping methods and cathartic techniques may help a person to feel better temporarily, but they don’t resolve trauma so that it can no longer exert a negative effect on the client. Clients feel better temporarily after coping or having a catharsis, but the basic charge remains in place, and shortly thereafter they need more therapy. The need for anamnesis (recovery of repressed memories) Traumatic Incident Reduction operates on the principle that a permanent resolution of a case requires anamnesis (recovery of repressed memories), rather than mere catharsis or coping. To understand why clients have to achieve an anamnesis in order to resolve past trauma, we must take a person-centered viewpoint, i.e., the client’s viewpoint and, from that viewpoint, explain what makes trauma traumatic. Time and intention Let us start by taking a person-centered look at the subject of time. Objectively, we view time as a “never-ending stream”, an undifferentiated continuum in which events are embedded. But subjectively, we actually experience time differently. Subjectively, time is broken up into “chunks” which we shall call “periods” of time. “A time”, for me, is a period during which something was happening or, more specifically, during which I was doing something, engaging in some activity. Some periods of time are in the past; some are in the present. Those periods defined by completed activities are in the past; those defined by ongoing (and therefore incomplete) activities are in the present. The contents of present time For that reason, we don’t experience present time as a dimensionless point. It has breadth corresponding to the width of the activities in which we are currently engaged. For example, I am still in the period of time when I was a father, when I was attending this conference, when I was delivering this workshop, when I was uttering this sentence, when I was saying this word. These are all activities in which I am engaged, and each defines a period of time with a definite width. In fact, I am inhabiting a host of periods of time simultaneously. Activity Cycles A period of time has a simple but definite anatomy, determined by the activity in which you are engaged, which we call an “activity cycle” (or just a “cycle” ). The period of time (and the cycle) starts when the activity starts, continues as long as the activity continues, and ends when the activity ends. The activity in question may be related or unrelated to trauma. It could be trying to get away from a sniper, or it could be vacationing. For instance, the period of time “when I was going from Paris to Rome” starts when I begin the process of getting from Paris to Rome, continues while I get the train tickets, get on the train, and eat in the dining car, and ends when I arrive in Paris. If an activity has started but not ended for me, that period of time is still ongoing and is part of my present time. The Ruling Intention Moreover, each of the activities in which I engage is ruled by a governing intention. In the example I just gave, the intention was to get from Paris to Rome but, in the case of a combat veteran, it could be an intention "to get revenge". In effect, therefore, an activity cycle starts when I formulate an intention, continues so long as that intention continues to exist, and only ends when the intention is ended. Therefore, there is an intimate relation between time and intention. Each of the activities described in the travel example is coextensive with the existence of a corresponding intention. Each continues until the intention is fulfilled or unmade. Present time consists of periods of time that are determined by my current intentions. Ending an Intention In fact, there are only two ways to end an intention and thus to send a period of time into the past: Fulfill it: An intention ends more or less automatically when it is fulfilled; because you don’t keep intending to do things that you know you have already finished doing. Discontinue it: Even if an intention is not fulfilled, you can deliberately and consciously decide to unmake the intention. Unmaking it, however, requires that you be aware of it and of your reasons for making it. You cannot unmake an intention of which you are unaware. In other words, you can’t stop doing something you don’t know you are doing. The Effects of Repression Repressing an incomplete cycle makes it destructive and, at the same time, much more difficult to complete. As mentioned above, to complete a cycle, I must be aware of the intention that rules it. But if, because of the trauma it contains, I have repressed the incident in which I created the intention, I am not aware that I have that intention or why I have it, so I cannot unmake it! That period of time continues up into the present, and some energy remains tied up in it. In fact, it makes sense to define charge as “repressed, unfulfilled intention”. Getting rid of charge, then, consists of un-repressing intentions and then unmaking them. Now it becomes obvious why we need anamnesis in order to resolve the effects of past traumas. To reduce the charge contained in past traumas, the client must come fully into contact with them, so that he can find the unfulfilled intentions that he has repressed and why he formulates them, and unmake them. To Repress or Not to Repress? Whenever something painful and difficult to confront shows up in life, one has a choice. 1. Allowing oneself to experience it fully. a. Thus being fully aware of one’s intentions in the incident, and why one formed those intentions. b. Thus having a choice whether or not to unmake the intentions. c. At which point, the incident is discharged, by the above definition of “charge”, and becomes a past incident. or 2. Repressing it, wholly or partially. a. Thus not being aware of the intentions one made in the incident, or why one made them. b. Thus not being able to unmake those intentions. c. So that the incident remains charged and continues on as part of present time. Paradoxically, by trying to get rid of the incident by repression, one causes it to remain present indefinitely. Effects of Charge Charge represents a drain on a person’s energy or vitality, because energy remains tied up in the incomplete cycle connected with the intention in the trauma, and more is tied up in the effort to repress the incident. Hence a person with unresolved past traumas tends to be rather listless or goalless in life. A second effect of past traumas compounds the difficulty: similar conditions in the environment can trigger or “restimulate” past, repressed traumas, just as the sound of a bell could cause Pavlov’s dog to salivate. When one is reminded of a past trauma, one has, again, the choice given above: one can either allow oneself to become fully aware of what happened in the original incident or one can repress the incident of being reminded. Repression causes the “reminder” incident to become a secondary trauma in itself. Later, similar occurrences can then restimulate the secondary traumatic incident as well as the original one. Paradoxically, by trying to get rid of the incident by repression, one causes it to remain present indefinitely. A Sequence of Traumatic Incidents For example, consider a Vietnam combat veteran who has a past traumatic incident of being in a combat situation in which a close friend was killed. Contained in this incident are, say, the sound of a helicopter, a loud noise, the taste of chewing gum (assuming he was chewing gum at the time), and, perhaps, children (if he was in a Vietnamese village). Also, a tree line. Since this incident is extremely traumatic, the soldier represses it, at least partially. He “doesn’t want to think about it.” Later, some years after leaving Vietnam, he goes to a barbeque in the park. There, he is, say, chewing gum and sees some children. He also sees a tree line. He starts to be reminded of the original incident and feels the rage contained in it. This becomes uncomfortable, so he represses the incident in the park, wholly or partly. Contained in it were also a barbeque smell and a dog barking. In a later incident, he is talking with his wife and chewing gum, and they are barbequing on the back porch with the kids, the dog barks, and the veteran suddenly experiences a feeling of rage, because the earlier incident, the one in the park, is restimulated by the common elements: the dog barking, the barbeque smell, and the chewing gum. This is uncomfortable, so he represses this one also, and it becomes another secondary trauma. This incident also contains some additional elements: the sound of traffic, and the person’s wife. Later, he is drinking beer on the back porch with his baby and his wife and smoking a cigarette, and he is trying to talk to his wife but there is also traffic noise. Again, he flies into a rage because of the reminders, although, because the past trauma is repressed, he will attribute the rage to something else, e.g., to the fact that his wife forgot the salt shaker for the third time. This incident contains a sensation of being intoxicated, the taste of beer, the smell of cigarette smoke, and his baby. It, too, is repressed. Later still, he is smoking, drinking beer, and watching TV. The sensation of intoxication and of smoking reminds him of the earlier incident and he feels rage. Now whenever he gets drunk or watches television, he is prone to fly into a rage. Random dream elements restimulate the same sequence of traumas, resulting in recurrent nightmares. Finally, he goes to a therapist and is found to be a full-blown PTSD case. This is a sequence of traumatic incidents, starting with a “root” incident and encompassing, probably, a large number of subsequent incidents in which the root incident or one of its sequents got restimulated. The only thing in common to all these incidents is the feeling of rage that he experiences each time. He attributes this rage to something in present time, but it actually stems from the original rage he felt in the root incident. The Traumatic Incident Network Although we have only shown a few incidents, in real life a sequence may contain hundreds or even thousands of incidents. Furthermore, the average person usually has a fairly large number of these sequences, with different themes in common. These sequences overlap each other to form a network of traumatic incidents which we call the traumatic incident network or “Net” (See Fig. 4). The object of TIR is to reduce the amount of charge the Net contains so that the person is not subject to the restimulating effects described above, and also so that he can reclaim the intention units that are tied up in the Net. What we have shown, here, is not just the situation of a Vietnam combat vet or a rape survivor. It is the human condition. Every one of us has had at least some past traumas that cause us to be dysfunctional in certain areas of life -- the ones that contain restimulators. The Solution to the Net Stating the solution is easy, but accomplishing it is somewhat trickier. Traumas contain very intense, repressed, unfulfilled intentions, such as the intention to get revenge, to escape -- and, of course, the intention to repress the incident. The client needs to find the root incident for each sequence and bring it to full awareness. Traumatic Incident Reduction accomplishes this result. When that occurs, the person becomes aware of the intentions in them and, since these intentions are generally no longer relevant to the here and now, she unmakes them. At that point, the cycles contained in the incidents are completed; they become part of the past, and they can no longer be restimulated. Undoing Amnesia What is required, then, to obtain the necessary anamnesis? An incident has four dimensions, not just three. In order to be aware of an incident, it is necessary to start at the beginning and go through to the end, like viewing a motion picture, not like looking at a snapshot. Hence, we call the procedure “viewing”, the client a “viewer”, and we call the one who helps the client to do the viewing the “facilitator”. You can’t just glance at a part of an incident and expect thereby to have fully completed the process of anamnesis, because you will miss other parts of it -- probably the most important ones, the ones that are most difficult to confront. In order to achieve a full anamnesis, you must be allowed to go through the entire incident without interruptions, without reassurances -- in short without any distractions. Furthermore, it does not suffice to go through the incident only once. If you want to become fully familiar with a movie, you must see it a number of times, and each time you will notice new things about it. The same thing happens during Traumatic Incident Reduction, except that the client is viewing a past traumatic incident instead of a movie, and that’s somewhat harder to do. Basic vs. Thematic TIR If, as is often the case with combat vets and rape victims -- survivors of single or discreet incidents -- the viewer already knows which trauma needs to be looked at, you can use a relatively simple form of TIR called “Basic TIR”. You simply have the viewer go through the single, known incident enough times to resolve it. But in most cases, the viewer starts out being entirely unaware of what the root trauma underlying his difficulties is. So how can he find it? For that, we use a technique called “Thematic TIR”, in which we can trace back an unwanted feeling, emotion, sensation, attitude, or pain to the root trauma from which it originates. End Points When the viewer finds and discharges the root incident, a very specific and often quite dramatic series of phenomena appear, showing that the viewer has achieved a thorough discharge. Then we say the viewer has reached an “end point”. These phenomena usually appear in the following order: #Positive indicators: The viewer appears happy, relieved, or serene. She is not sitting in the middle of something heavy. Sometimes she will laugh or say something cheerful. In the absence of good indicators, a full end point has not occurred. #Realization: Then the viewer will usually voice some kind of realization or insight, a reflection of the fact that he is becoming more aware. #Extroversion: Finally, the viewer will open her eyes or otherwise indicate that her attention is now back in present times. She will usually look at the facilitator or at the room, or make some comment about something in the here and now. #Intention expressed: Often, the viewer will explicitly tell the facilitator what intention was present in the incident. If he doesn’t, the facilitator has the option of asking him to tell of any decisions he may have made at the time of the incident. When you see an end point, the most important thing to do is to stop. If you continue past the point when the root incident has been discharged and continue to ask the viewer to look for incidents, she will start to wander around more or less randomly in the Net, and will often end up triggering a lot of things that you may not be able to resolve with TIR. This is defined as an overrun. Results Practitioners claim that TIR works well with most clients who fit the criteria for PTSD. An exception is that TIR does not work well with people who are currently abusing drugs or alcohol. When the viewer was drinking heavily or abusing other substances between sessions, it would fail virtually every time. Another contraindication is if the client is diagnosable with some type of psychosis. Although the TIR procedure is not complicated or difficult to learn, it can only work in a session environment that is structured in such a way that it is safe. Much of the TIR training involves teaching certain Rules of Facilitation and communication skills specific to the TIR style of working with a client. References * French, G.R. & Harris, C.J. (1998) Traumatic Incident Reduction (TIR). Boca Raton, FL: CRC Press. (Out of Print) * Volkman, V.R. (2005) Beyond Trauma: Conversations on Traumatic Incident Reduction. Ann Arbor, MI: Loving Healing Press. ISBN 1-932690-04-2 * Volkman, V.R. (2005) Traumatic Incident Reduction: Research & Results. Ann Arbor, MI: Loving Healing Press. ISBN 1-932690-11-5 Category:Psychotherapy :sr:Метапсихологија